Sorge F
Groupe de Pédiatrie Tropicale (GPTrop), Société Française de Pédiatrie, Département de Pédiatrie, Hôpital Saint Vincent de Paul, 82 boulevard Denfert-Rochereau, 75014 Paris, France.
Arch Pediatr. 2009 Oct;16 Suppl 2:S115-22. doi: 10.1016/S0929-693X(09)75313-8.
Use of topical insect repellent is an important component in prophylaxis of arthropod bite vector borne diseases. Topical insect repellent are used in a three part management regimen, along with impregnated clothing and mosquito netting. Parental training for efficacious and secure use of repellents for their children is essential part of a successful strategy to combat Lyme borreliosis, dengue fever, Chikungunya, West Nile virus infection and malaria, amongst children, according to local epidemiological risks. Rational repellent prescription for a child must take into account age, active substance concentration, topical substance tolerance, nature and surface of the skin to protect, number of daily applications, and the length of use in a benefit-risk ratio assessment perspective. The 4 currently repellents recommended by Whopes (Who) for their long lasting efficacy and patient tolerance are: 1) Citriodiol (PMD), 2) DEET, 3) Icaridine (KB3023), and 4) IR3535. In field trials the minimum required concentration of each four of these agents to be effective for 3 hours against most arthropods is 20% (in cream, roll-on or spray vehicle). Described side effects of these agents are mild, being limited to local irritative dermatitis and allergy. The risk of severe side effects has been related to DEET misused and neurotoxicity. The international recommendations concerning utilization of topical repellent amongst children for prophylaxis of arthropod borne diseases is concerning short term usage (several weeks). But the use of repellent is sub chronic or chronic amongst the majority of children living in subtropical regions where these vector borne diseases are endemic. And toxicity of topical repellent when used sub-chronically and chronically is not well studied in pediatric age groups. Taking into account these considerations, the current recommendations of the French Group of Tropical Paediatrics are to teach the parents of children who live in arthropod vector disease endemic regions to use topical insect repellent on their children with the recommended age related frequency in the following way: the use of topical repellent in infants above 6 months, once daily. Only in exceptional circumstances of severe arthropod exposure risk, their brief use in nursing infants as young as 2 months is acceptable, however with never more than 1 application daily. From ages 1 to 12 years, 2 applications daily may be safely used; 3 applications daily after 12 years old through adulthood.
使用局部用驱虫剂是预防节肢动物叮咬传播疾病的重要组成部分。局部用驱虫剂与浸药衣物和蚊帐一起用于三部分管理方案中。根据当地的流行病学风险，对家长进行关于有效且安全地为孩子使用驱虫剂的培训，是在儿童中防治莱姆病、登革热、基孔肯雅热、西尼罗河病毒感染和疟疾等疾病的成功策略的重要部分。为儿童合理开具驱虫剂处方时，必须从效益风险比评估的角度考虑年龄、活性物质浓度、局部用药耐受性、要保护的皮肤性质和表面、每日用药次数以及使用时长。世界卫生组织（WHO）目前推荐的四种具有长效功效且患者耐受性良好的驱虫剂为：1）香茅二醇（PMD），2）避蚊胺（DEET），3）派卡瑞丁（KB3023），4）IR3535。在田间试验中，这四种药剂中每种对大多数节肢动物有效的最低所需浓度为20%（乳膏、滚涂剂或喷雾剂剂型）。这些药剂所描述的副作用较为轻微，仅限于局部刺激性皮炎和过敏。严重副作用的风险与避蚊胺的滥用及神经毒性有关。关于儿童使用局部用驱虫剂预防节肢动物传播疾病的国际建议是短期使用（几周）。但在这些媒介传播疾病流行的亚热带地区，大多数儿童使用驱虫剂是亚慢性或慢性的。而局部用驱虫剂在儿科年龄组中亚慢性和慢性使用时的毒性尚未得到充分研究。考虑到这些因素，法国热带儿科学组目前的建议是，教导生活在节肢动物媒介疾病流行地区的儿童家长，按照以下与年龄相关的推荐频率为孩子使用局部用驱虫剂：6个月以上婴儿每天使用一次。仅在节肢动物暴露风险极高的特殊情况下，可在2个月大的哺乳期婴儿中短暂使用，但每天使用次数不得超过1次。1至12岁儿童每天可安全使用2次；12岁以上至成年每天可使用3次。
